Age-related systemic diseases can cause significant health issues for older adults. Some key diseases include hypertension, anemia, congestive heart failure, vasculitis syndrome, and cerebrovascular disease. Management may involve treating underlying causes, lifestyle changes, and medications. It is important to control risk factors and symptoms of these conditions to prevent end-organ damage and other complications. Early diagnosis and aggressive treatment can help improve outcomes for older patients.

1. Age Related Systemic
Diseases.
Ananta poudel
BOVS,NAMS 1ST batch
1

2. Introduction to ageing.
Ageing results from the impact of the accumulation of
a wide variety of molecular and cellular damage over
time which leads to a gradual decrease in physical and
mental capacity, a growing risk of disease, and
ultimately, death.(WHO, fact sheet, 05-02-2018)
2

3. Cont.
Various theories have evolved to improve our
understanding of the ageing process, such as;
1. Molecular and cellular theory
2. Systemic theory
3. Immunologic theory
4. Waste product theory
3

4. Cont.
• Ageing is also characterized by several complex health states
( geriatric syndromes)
Some of the age related diseases as follows:
1. Hypertension
2 . Anemia
3. Congestive heart failure
4. Vacuities syndrome
5. Cerebrovascular disease
6.COPD
7. Arthritis
4

5. Cont.
8. peripheral arterial disease
9. Diabetes
10.Thyroid disease
11. Tuberculosis (TB)
12. Hypercoagulability and anticoagulation
13. Atherosclerosis
14. Coronary artery disease
5

6. Hypertension(HTN,BP)
• systemic arterial hypertension is characterized by
persistently high blood pressure (BP) in the systemic
arteries.
• Commonly expressed as the ratio of the systolic BP and
diastolic .
• Other terms; pulse pressure 40 mmof Hg and mean arterial
BP 93mmof Hg.
6

7. 7

8. • Prevalence of HT increases with age & greater
among African Americans.
8

9. Risk Factors
• Increased age.
• Cigarette smoking, obesity
• Inactive lifestyle, high dietary sodium levels
• Alcohol consumption and poor nutrition.
• Stress
• Chronic kidney diseases
• Hypercholesterolemia
• Too much salt diet
9

10. Symptoms
• Headache
• Epistaxis
• Tinnitus.
• Chest pain
• Difficulty breathing
• Irregular heartbeat
• Blood in the urine
• Pounding in chest, neck, or ears.
10

11. Sign of HTN
• Dizziness
• Nervousness
• Sweating
• Trouble sleeping
• Facial flushing
• HTN retinopathy
11

12. Path physiology
 Flawed regulation of BP by Renin-Angiotensin-
Aldestrone mechanism. (Long Term)
12

13. 13

14. Non pharmalogical management
• Weight reduction
• Decrease sodium intake
• Regular physical exercise
• Healthy eating habits
• Discontinue alcohol
14

15. Pharmalogical management
• Diuretics. eg- hydrochlorothiazide
• Angiotensin-converting enzyme (ACE)
inhibitors. eg- lisinopril
• Calcium channel blockers.eg- amlodipine
15

16. Anemia.
• Anemia is defined as a decrease in red blood cells or
hemoglobin resulting from blood loss or impaired
production or destruction of red blood cells.
16

17. Daily iron demand
• Male = 1gm
• Adolescence =2-3 mg
• Female in rep.age=2-3 mg
• Pregnant=3-4 mg
17

18. Classification of anemia
 On the basis of morphology:
-Normocytic anemia
-Microcytic anaemia
-Macrocytic anaemia
 On the basis of cause:
-Blood loss
-Inadequate production of normal blood cells
-excessive destruction of blood cells
normal 80-100 fl
18

19. Pathophysiology
Decrease in RBC,HB
Decrease in oxygen carrying capacity
Hypoxia and hypoxia induced effects on organ function
Sign and symptoms of Anemia
19

20. Risk factors
• Poor socioeconomic condition
• Teenage pregnancy
• Menstrual problem
• Intestinal disorder
• Family history
• Age factor
• Regular blood donors
• Persistent hematuria
• Mediaction-eg, Antacid
20

21. Clinical features
21

22. Atrophy of
papilla
Brittle nail
Pale
Eye,skin
22

23. Management
 Treatment of underlying causes.
 Dietry intake; green leafy vegetables, meat, egg
etc.
Iron-deficiency anemia: Iron supplements and
dietary changes.
Vitamin deficiency anemia: Treatments can include
dietary supplements and vitamin B-12 shots.
23

24. Cont.
• Anemia due to chronic disease: Resolving the
underlying condition.
• Aplastic anemia: Treatment involves blood
transfusions or bone marrow transplants.
• Sickle cell anemia: oxygen therapy, and intravenous
fluids, folic acid supplements, blood transfusions
24

25. Congestive heart failure
• Congestive heart failure (CHF) is a condition in
which cardiac output is insufficient to meet
physiological demands because of impaired
function of one or both cardiac ventricles.
• Heart failure is common in patients older than 65
years.
25

26. Congestive heart failure
26

27. CHF types by laterality
• Right heart failure (RHF): CHF due to right
ventricular dysfunction and left heart failure as well.
• Left heart failure (LHF): CHF due to left ventricular
dysfunction; decrease in pumping mechanism
causing backflow of blood towards lungs.
• Biventricular (global) CHF: CHF in which both the
left and right ventricle are affected.
27

28. Risk factors
• Coronary artery Diseases
• Myocardial Infarction
• Hypertension
• Diabetes
• Heart Valve Disease
• Smoking
• Obesity
28

29. • Previous heart attack
• Congenital heart defects
• Infection of heart muscles
• Conduction defects
• Large amount of salt intake
29

30. Normal heart Congestive heart
30

31. Symptoms
Dyspnea (shortness of breathe)
• Exercise intolerance
• Tachypnea (increase respiration rate)
• Cough
• Fatigue
• Nocturia
• Abdominal pain
• Nausea
• Bloating (belly feels swollen)
• Poor appetite
31

32. Sign.
• Pulmonary edema
• Cool extremities
• Pleural effusion
• Stokes respiration
• Tachycardia
• Narrow pulse pressure
• Cardiomegaly
• Peripheral edema
• Jugular venous distension
• Hepatomegaly
32

33. Management
 non pharmacologic, pharmacologic, and invasive
strategies to limit and reverse its manifestations.
 Treatment of underlying causes.
​ nonpharmacologic therapies include:
-dietary sodium and fluid restriction.
 physical activity as appropriate; and attention to weight
gain.
Oxygen therapy
33

34. Pharmacologic therapies : use of diuretics,
vasodilators, inotropic agents, anticoagulants, beta-
blockers.
Angiotensin-converting enzyme inhibitors (ACEIs) or
angiotensin receptor blockers (ARBs) for neuro-
hormonal modification and vasodilatation.
34

35. Invasive therapies for heart failure include :
• -pacemakers,
• -coronary artery bypass grafting (CABG) .
• -valve replacement.
35

36. vasculitis syndrome
• Vasculitis is a heterogeneous group of disorders
characterized by inflammatory destruction of blood
vessels
36

37. Cont.
• Inflamed blood vessels are liable to occlude,
rupture or develop a thrombus leading to ischemia
of tissues and organs supplied by the vessel.
• Immune system attacks healthy blood vessels,
causing them to become swollen and narrow.
37

38. Types of vasculitis are grouped according to the size of the
blood vessels affected.
• Large vessel – temporal arteritis (giant cell arteritis)
• Medium vessel : cutaneous vasculitis, Kawasaki disease
• Small vessel eg. Polyangiitis.
38

39. Causes
 When the immune system mistakenly sees blood vessels as
a foreign invader and attacks them.
 These conditions can occur by themselves or with other
rheumatic diseases.
 Other possible triggers include an infection (hepatitis B or
C) or a medication side effect.
 Vasculitis also may be linked to certain blood cancers, such
as leukemia and lymphoma 39

40. clinical features
Muscles and joints:
-Pain,
-inflammation,
- joint pain and swelling
Nervoussystem:
- headache,
-stroke,
-tinnitus,
- Reduced or loss of vision
Splinter hemmorage
temporalGiant cell arteritis
40

41. • Heart and arteries: Heart attack, high blood pressure.
• Respiratory tract: Nose bleeds, bloody cough, lung
infiltrates
• GI tract: Abdominal pain, bloody stool, GI perforations.
• Kidneys: Inflammation of the kidney's filtration units
(glomeruli)
41

42. Symptoms
1. Fatigue
2. Weakness
3. Fever
4. Abdominal pain
5. Proteinuria , hematuria
6. Nerve problems (numbness , weakness)
7. Skin rash
8. Weight loss
 It can also cause specific problems, depending on the
body part that’s involved.
42

43. Management
• Corticosteroids are the treatment of choice.
• Immunosuppressant's
• Antihypertensive therapy
• Careful fluid management
• Attention to renal impairment and blood transfusion
43

44. • Early diagnosis
• Aggressive treatment are necessary to prevent
end-organ damage.
44

45. CEREBROVASCULAR DISEASE
(stroke)
• Cerebrovascular disease is a heterogeneous group of
vascular disorders that result in brain injury.
• Stroke incidence and mortality rate increase with age,
especially after age 65 years.
45

46. 46

47. • This age group comprises almost 90% of the mortality rate
of stroke.
• Stroke causes loss of motor and cognitive skills, resulting in
much greater dependency on the families and other
caregivers.
• Complications of stroke may be more devastating than
the stroke itself because strokes activate the body’s
clotting system.
47

48. Types of stroke
1. Ischemic stroke: Blood vessel carrying blood to the
brain is clogged by blood clot.
Further divided into :
 Thrombotic stroke
 Embolus stroke
48

49. • Blood
vessels
Clot of blood by
different risk factors
(embolus,thrombus,
cholesterol air plaque
etc
Occlusion of
vessels
supplying O2
in brain cells
Reduction
of O2 in
brain cells
Reasult in ischemic stroke
49

50. 2.Heamorrhagic stroke
 Second major cause of stroke.
 Cause mainly due to aneurysms, rupture of these result in
haemorrhagic stroke.
50

51. Risk factors
• Age
• Gender (male > female)
• Race (Afro-Caribbean > Asian > European)
• Heredity Previous vascular event, e.g. MI, stroke or
peripheral embolism
• High fibrinogen
• High blood pressure
51

52. Cont.
• Heart disease
• Diabetes mellitus
• Hyperlipidaemia
• Smoking
• Excess alcohol consumption
• Oral contraceptives
• Atrial fibrillation (arrhythmia)
52

53. Symptoms
• The symptoms of stroke depend on what part of the brain
is damaged.
• SUDDEN development of one or more of the following
above indicates a stroke.
• Weakness or paralysis of an arm, leg, side of the face, or
any part of the body.
53

54. Symptoms cont.
• Numbness
• Tingling
• Decreased sensation Vision
• Changes Slurred speech
• Inability to speak or understand speech
• Difficulty reading or writing
• Swallowing difficulties
• Drooling Loss of memory
54

55. Cont.
• Drowsiness
• lethargy
• loss of consciousness
• Vertigo (spinning sensation)
• Loss of balance or coordination
55

56. Warning sign !
56

57. Management of stroke
Aim:
 Preserving life.
 Minimizing residual deficits.
 Reducing ICP.
 Preventing extension or recurrence.
57

58. Factors minimize risk for having a stroke by:
 eating more vegetables, beans, and nuts,seafood instead
of red meat and poultry
 Limiting intake of sodium, fats, sugars, and refined grains
 Increasing exercise.
 Limiting or quitting tobacco, alcohol.
 Taking prescribed medications for conditions, such
as high BP, as directed. 58

59. Pharmacological management
 Anti coagulants, Anti-platelet therapy: (Heparin, Warfarin,
 Edema control: (steroid, osmotic diuretics (Mannitol).
 Antihypertensive, mild analgesics.
 Seizure control: eg.phenytoin
 Thrombolytic Agents (if blood Clot)
59

60. Surgical approaches.
 External ventrisculotomy drainage
 Epidural (Clot): Excision & Drain
 Extra / Intra-cranial bypass
 Anurysms : clip
 Rehabilitation; if certain parts body are attacked by
stroke. 60

61. 61

62. Chronic obstructive pulmonary
disease (COPD)
• Chronic obstructive pulmonary disease (COPD) is a group of
diseases including chronic bronchitis and emphysema that
are characterized by airway obstruction.
• COPD is also known as chronic obstructive lung disease
(COLD), chronic obstructive airway disease (COAD), chronic
airflow limitation (CAL) and chronic obstructive respiratory
disease (CORD).
62

63.  An estimated 210 million people worldwide have COPD.
 More than 3 million people died of COPD in 2005,this
represented 5% of all deaths worldwide .
 COPD disproportionately affects the world's poorest WHO
, 2009.
 COPD Is Deadly But Treatable & Preventable disease.
63

64. 64

65. Pathophysiology
persistent Exposed to, pollutants and noxious agent
Chronic inflammation of Bronchi & alveoli
Mucus gland hyperplasia
Narrowing and reduction in the number of small airways
airflow limitation and leads to decreased gas transfer capacity
Alveoli hypoxia, oxidative stress
Impaired repair mechanism
Airway collapse due to the loss of attachment caused by alveolar wall destruction in
emphysema
65

66. 66

67. COPD includes chronic bronchitis and
emphysema
 Asthma is not considered part of COPD due its
reversibility.
 1. Chronic bronchitis: is a chronic inflammation of the lower
respiratory tract characterized by excessive mucous
secretion, cough, & dyspnea associated with recurrent
infections of the lower respiratory tract.
 Productive cough for at least 3 months or at least 2
consecutive years
67

68.  Absence of any other identifiable cause of excessive
sputum production
 Airflow limitation that is not fully reversible
 Abnormal inflammatory response to noxious agent - e.g.,
smoking
68

69. 2. Emphysema: Complex lung disease characterized by
damage to the gas- exchanging surfaces of the lungs
(alveoli)
Characterized by :
 Alveolar wall destruction
 Irreversible enlargement of air spaces distal to the terminal
bronchioles Without evidence of fibrosis
69

70. Risk factors
Exposure
Tobacco smoke
 Bio mass fuel smoke
open fires
Chronic uncontrolled asthma
 Occupational dusts and chemicals
 Infections
 Overcrowding
Damp (moisture)
 Low socioeconomic status
 Advanced age
70

71. • Shortness of breathe.
• Chronic cough. Main symptoms
• Sputum
• weight loss
• Tiredness
• chest pain less common
• coughing up blood
71

72. Physical signs
 Barrel-shaped chest
 Accessory respiratory muscle participate.
 Prolonged expiration during quiet breathing.
 Expiration through pursed lips Paradoxical.
 Tripod position to relieve dyspnea (shortness of breathe)
72

73. Management
Risk reduction:
 Patient education and public awarness
 Cessation smoking is the single most effective intervention
or slow its progression to prevent COPD .
 Avoid outdoor air pollutant, overcrowding, damp
environment .etc
 Bronchodilators: Relieve bronchospasm and reduce airway
obstruction by allowing increased oxygen distribution
throughout the lungs and improving alveolar ventilation.
73

74. Cont.
 Inhaled and systemic corticosteroid as well.
 These medications, which are central in the management of COPD
are delivered through a metered-dose inhaler (MDI) by nebulization.
 Oxygen therapy:
Oxygen therapy can be administered as long- term continuous
therapy, during exercise, or to prevent acute dyspnea.
 Breathing exercise.
 Patient education.
74

75. Surgical management
• Bullectomy: surgical removal of enlarged airspace which do
not contribute in ventillation.
• Lung reduction Sx: removal of part of diseased lung that
allow functional tissue to expand and relax.
• Lung transplantation in extreme cases.
75

76. Arthritis
 Arthritis is defined as inflammation of one or more joints,
leading to pain and stiffness that can worsen with age.
 The most common cause of chronic inflammatory joint
disease.
76

77. Cont.
• When joints are inflamed they can develop stiffness,
warmth, swelling, redness and pain.
• There are over 100 types of arthritis.
( osteoarthritis, rheumatoid arthritis, ankylosing
spondylitis, psoriatic arthritis, lupus, etc)
• A systemic autoimmune disease and changes can be
widespread in a number of tissues of the body.
77

78. • Affects 1 – 3% of the population world wide.
• Peak prevalence between the ages of 30 and 50
years.
• Women are affected 3 or 4 times more commonly
than men.
78

79. Some types of arthritis
• Rheumatoid arthritis (RA) : is an chronic autoimmune and
inflammatory disease.
• Ankylosing spondylitis (AS) :is a type of arthritis in which there is a
long-term inflammation of the joints of the spine.
• Psoriatic arthritis PA: is a condition involving joint inflammation
(arthritis) that usually occurs in combination with a skin disorder
called psoriasis
• Lupus is a long-term autoimmune disease in which the body's
immune system becomes hyperactive and attacks normal, healthy
tissue; causes symptoms like joint pain, tiredness and skin rashes etc.
79

80. Osteoarthritis.
 Osteoarthritis (OA) is a non- inflammatory degenerative joint disease
characterised by progressive loss of articular cartilage with associated
new bone formation and fibrosis.
 Chronic degenerative is a classic age-related disorder.
 Loss of the articular cartilage is a central feature attributed to "wear
and tear
 relationship between aging and OA is that aging of the
musculoskeletal system increases the susceptibility to OA
80

81. 81

82.  Risk factors :
 Age
 Obesity
 Joint injury
 Genetics
 Anatomical abnormalities
 Degenerative changes
 Female
 Repetitive loading
 Muscle weakness
Joints involving in
osteoarthritis 82

83. Symptoms
• Lasting joint pain
• Joint swelling
• Joint stiffness
• Tenderness
• Problems using or moving a joint normally
• Warmth and redness in a joint
• Loss of function.
83

84. Sign
 Tenderness-In the musculoskeletal examination
 Crepitation- palpable or audible grating or crunching sensation
produced by motion
 Deformity of the joints may manifest as a bony enlargement,
articular subluxation, contracture.
 Joint instability is present when the joint has greater than normal
movement in any plane.
84

85. Management.
 Protection of affected joints from overloading Weight loss
Use of walking stick
 Exercise of supporting muscles around joints to avoid
wasting.
 Supportive measures such as pain relief by analgesics or
NSAIDs.
 Hyaluronic acid injections.
 Glucosamine & chondroitin
 Surgical treatment
85

86. References
• Vision and ageing ,Rosenbloom & Morgan’s
• medscape.com/article
• ncbi.nlm.nih.gov/article
• arthritis.org/diseases/vasculitis/article
• Internet via various website.
86

87. 87